Most valuable skin treatment? Try sunscreen.

This article from U.S. News & World Report by Lindsay Lyon gives away the biggest secret in dermatology: patients wouldn't need us so much if they would just protect their skin!

Aging of the skin comes in 2 kinds: intrinsic aging and extrinsic aging. Intrinsic aging is genetic and cannot be changed. The apple does not fall too far from the tree. So if your parents have great skin you may be lucky as well.

Extrinsic skin aging has nothing to do with genetics. It is related to environmental exposure. Such exposure includes wind, the elements and most importantly ultraviolet exposure from the sun. The more sun you get, the quicker your skin will age. The answer is easy. The most important thing we can all do is to protect our skin with sunscreens. Topical antioxidants and retinols also can help. Sunscreens at any age are a great idea. The problem is that over 90% of our sun exposure has occurred by the time we are 20 years old.

What happens in our 30s, 40s 50s and beyond? What do we do about the wrinkles, red spots and sunspots we have accumulated during the years beyond our teens? Yes, it is wise to use sunscreens at any age, but unfortunately ultraviolet protection does not reverse any of the sun damage we already have. Thankfully today we have a whole variety of non-surgical lasers that can rejuvenate the skin and reverse a lot of the damage: Fraxel, ProFractional, Titan, Accent, and Thermage treatments. You can easily erase so much cosmetic extrinsic skin aging.

Today’s laser technology has revolutionized the treatment of extrinsic aging of the skin. But don’t even think about such treatments unless you combine them with the simplest of all cosmetic treatments – a sunscreen.

Thanks for reading,

Dr. David J. Goldberg
Skin Laser Surgery Specialists of NY/NJ
Sanctuary Medical Aesthetic Center

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

What you need to know about bioidentical hormones

According to Google Trends, more people are searching for bioidentical hormones on the Internet than any other time in history:

It's likely to continue, as Oprah has devoted a lot of her media empire to a discussion of bioidentical hormones replacement therapy, which she is crediting for revitalizing her life. Today, she'll have Suzanne Somers on her show, which should prolong this interest.

Our bioidentical specialist at SMAC is Dr. Mitchell Matez. You can find out more about him on our website, but to clear up what bioidentical hormones are I asked him a few questions:

Q: What is the difference between bioidentical hormones and synthetic hormones?

A: Bioidentical Hormones are exact molecular copies of the hormones that naturally occur in the human body. This is in direct contrast to hormones supplied by the pharmaceutical industry and/or mainstream Gynecologists which are either chemically altered versions of human hormones or animal hormone (i.e. Premarin is horse estrogen). These are termed synthetic and are not naturally occurring in the body. We are designed to recognize and utilize our natural hormones, not those of a horse.

Q: Why aren't bioidentical hormones FDA approved?

A: Bioidentical hormones ARE FDA approved. There are a number of bioidentical products available commercially. Unfortunately they are produced with a “one size fits all” mentality which is not conducive to individualized therapy. Compounding pharmacies can provide customized formula for each individual.

Q:What menopausal symptoms can be reversed by BHRT?

A: ALL menopausal symptoms can be reversed with BHRT. In fact Menopause itself can be completely reversed!

Q: Are they safe?

A: There is a safety profile for Bioidentical hormones dating back over 70 years. There have been multiple studies demonstrating this. They are safe and effective, and do not carry the significant risks associated with synthetic hormones.

At SMAC our anti-aging division is well versed in BHRT. Dr. Mitchell Matez has brought to us an unparalleled expertise in the South Florida region. He uses personal evaluation, blood work, and other factors to determine your particular needs. Dr Matez has had extensive training and experience in Hormone Therapy and has been treating people throughout South Florida, United States, and abroad. Don’t forget to ask about Hormone “Pellets” which is a unique and efficient way to receive therapy.

Dr. Jason Pozner

Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg

Sanctuary Medical Aesthetic Center

Skin Laser Surgery Specialists NY/NJ

Wired Magazine: Playboy Playmates get skinnier, stay buxom. Average American: Not So Much.

This month's issue of Wired Magazine has a great chart in their Infoporn section plotting the BMI of every Playboy Playmate since 1954. This wealth of information is then compared to the average BMI of American women for every period of time.

As Playmates have gotten skinnier, American women have statistically become curvier. In 1960, the average BMI for women was 22.2, not far off from the pin-up girl "ideal" of 19.4.

This can probably be attributed to some help with plastic surgery.


From the article:

"On the touchy subject of implants, Playboy's policy seems to be don't ask, don't tell. We plotted each model's bust size (chest circumference at the fullest points) and cup size (breast volume) for all years that data were available (early '90s to now). While busts have shrunk faster than your 401(k), cup size has remained a buxom C or D. We don't think evolution can explain this phenomenon."

With our practice, the biggest change we're observing is the fit 40-something woman. After childbirth, many of our patients choose to take care of themselves and can have better bodies than most 20 year olds.

Maybe they have a little help in the breast department, and occaisonally some liposuction or a tummy tuck, but the "fit 40" is the epitomy of the Playboy ideal, and it's not as far-fetched as it may seem.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David J. Golberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

Dying for a Tan? Try Melanotan! (not really)

The blog Stylelist has reported on the international trend of injectable tanners, which continues to grow despite having any actual research into their long term effects.

From the blog:

"Since Melanotan activates melanocytes in the skin, it has the potential to cause cancer, as melanocytes are the cells that become cancerous in malignant melanoma. In short, Melanotan may be tricking the body into thinking it's getting more sun exposure than it actually is, which is NOT a good thing.

And there are short term side effects too: They include depression, suppressed appetite, nausea, high blood pressure, facial flushing and panic attacks. But according to a recent article in The Daily Mail, despite these dire warnings women are continuing to use the drug.

"But I feel fine using these jabs. I want to look my best at parties in strappy evening dresses and these tanning jabs give me the best colour I've ever had," says Vicky. "Far from doing me any harm, in these dark, wintry days, seeing myself glowing with health has given me a fantastic boost."

Almost all people now know that wonderful tan produced by ultraviolet exposure comes with the risks of skin cancer, wrinkles and accelerated aging of the skin. Despite this, millions of people spend hours on the beach or spend hundreds to thousands of dollars at “suntan parlors” doing their very best to get ultraviolet induced wrinkles and potentially deadly melanoma skin cancers.

Those who love the color of a suntan without the ultraviolet associated risks use a variety of artificial topical bronzing agents. Over the course of the last 2 decades these substances have become easier to use and generally look quite good. But know an even easier “natural” way to produce a tan has appeared – injectable melatonin. This substance when injected into humans produces melanin , the dark, protective pigment that increases after natural sun exposure. After 10 days of injections, users enjoy a warm, golden tan.

People are buying this substance at gyms, from beauty parlors and online. Of note in the UK the drug is legal to buy, but illegal to sell. Amazingly, this substance is also being marketed as an appetite suppressant, a rosacea treatment and even a sexual stimulant. The problem is that this substance has not undergone any regulatory testing to look at its potential long term side effects.

Thanks for reading,

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Plastic surgery legend Joan Rivers was in town

Joan Rivers, the comedienne who went from mocking other people's plastic surgery to mocking her own plastic surgery, was in Palm Beach this week to promote her book, "Men are Stupid... And They Like Big Boobs."

According to the write-up by Robert Janjigian at the Palm Beach Daily News, the event was held at The Brazilian Court's Cafe Boulud with a packed house.

The appearance was part of her book tour, which is billed as a guide to beauty and plastic surgery. Contrary to public opinion about her, she actually had some sound advice:

• "God bless the Internet." You can do a little background check on the guy (or woman).
  
• Ask your hairdresser. "They see everything."
• Choose a doctor who you feel comfortable talking to. who answers your questions thoroughly.
• Go to a specialist. "If you're getting your eyes done, go to an eye guy. If getting your breasts done, go to the breast specialist. It may be boring for them, but so what?"
• If you can afford it, get a cardiologist to sit in during the surgery. "Just in case."
• With Botox and other injectables: "Better they put in too little than too much. I don't want to look like Liza Minelli."
• "Don't be cheap about it. This is you. You can't leave this in the car."
• "Put the money where they can see it."
• When going in for collagen or other injections, make the doctor numb your face or get a presciption for the stuff that numbs you before you go in. "You want to feel nothing."
• "Ask, ask, ask before you go for it."

Thanks for reading,
Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

The New Mentor Implant

We're proud to say that we're participating in Mentor's study for their upcoming adjustable implants.

The new Mentor adjustable breast implant is 80% silicone and up to 20% saline. I am one of 30 plastic surgeons chosen by them to be an investigator for it.

The photo is of Dr. Hilton Becker of Boca Raton (co-investigator and inventor of the implant) and Dr. Robert Ray of Dr. 90210 fame (also a co-investigator). As you can see, this is a high-profile implant and becomes even more so when saline is added to the inner lumen.

Doctors can adjust size on the table, or with a buried port can adjust up to 6 months after surgery. The study is for primary augmentations and revision surgeries, with sizes ranging up to over 900cc.

This is the first in an innovative series of adjustable silicone implants that Mentor in working on. Women who are interested in this implant, please e-mail me and I'll refer to the closest investigator.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

In case you missed it... Oprah's Episode on Bioidentical Hormones

Most of us missed the Bioidentical Hormone episode of Oprah due to the water landing in the Hudson River. Someone put it up on Youtube in five segments: enjoy it while it lasts:











Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

In the news: Teen Plastic Surgery

The NY Times' Skin Deep series turned its attention to teenage plastic surgery on Thursday, with an article by Camille Sweeney, as well as the popular blog Jezebel. Our colleague Dr. Rick Lukash weighed in along with Dr. Alan Gold to say that it's acceptable for teenagers to have cosmetic surgery, as long as they are medically and mentally able to handle it.

From the article:
"The latest figures from the American Society for Aesthetic Plastic Surgery show that the number of cosmetic surgical procedures performed on youths 18 or younger more than tripled over a 10-year period, to 205,119 in 2007 from 59,890 in 1997. This includes even more controversial procedures: liposuctions rose to 9,295 from 2,504, and breast augmentations increased nearly sixfold, to 7,882 from 1,326. ... Dr. Frederick Lukash, a plastic surgeon in New York City and Long Island who specializes in treating adolescents, said: “Unlike adults who may elect cosmetic surgery for that ‘wow’ factor to stand out in a crowd, to be rejuvenated and get noticed, kids have a different mantra. They do it to fit in.”

In my experience, almost all teen plastic surgery patients and their parents that have consulted with me have been very reasonable. Most common request is rhinoplasty at age 16, which is acceptable since the nose has mostly stopped developing by then.



Requests for breast surgery are mostly due to marked size development abnormalities. For those 18 and 19 seeking augmentation, the patients generally want to be "normal," and are seeking small implants and a cup change from A to B.

It's the moms who want the larger implants for themselves.

Thanks for reading,

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

Kythera on track to treat under-chin fat soon

Kythera is trying to make some scientific sense of the injectable lipolysis market, specifically for submental (under the chin, or neck) fat. Based upon this press release they are making some headway with their new pharmaceutical.

Dr. Goldberg pointed out that studies in the U.S. have only looked at lipomas (benign tissues composed of fatty tissue) thus far, but will soon evaluate neck fat.

We applaud the way they are approaching this in a scientific, controlled manner and eagerly await further results. As the press release notes, in a random evaluation of 220 Botox and filler patients, 73% had excessive submental fat.

Thanks for reading,

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center, Boca Raton
Skin Laser Surgery Specialists of NY/NJ

IMCAS Wrap-Up

I have co-directed the IMCAS for a decade and this was the most exciting ever. Among the 3,500 attendees were cosmetic dermatologists, plastic surgeons and a variety of other physicians interested in cosmetic and anti-aging medicine. Much of the newer skin cosmetic techniques are presented at this meeting before they become available in the US. For example there were a variety of new wrinkle fillers discussed at IMCAS that are not yet sold in the US. This will soon change.

Currently we have great wrinkle fillers in the US . These include Restylane, Juvederm, Radiesse, Evolence and Sculptra. Soon we will have new fillers. These include Novielle, Voluma and Revanesse (see generic stock photo below).


Novielle represents a group of wrinkle fillers that contain a unique gel polymer. This material is currently undergoing FDA evaluations at several centers, including our New Jersey and Boca Raton, FL offices.

Voluma contains hyaluronic acid, the same wrinkle filler material contained in Restylane and Juvederm. However, the material in Voluma is thicker and will be used for facial sculpturing – an attempt to expand the concept of the liquid facelift.

Finally, Revanesse is another hyaluronic acid now available in both Europe and Canada. All these substances will help to continue the development of non-invasive, non-surgical medicine.

David J. Goldberg, MD
Skin Laser & Surgery Specialists of NY/NJ
Sanctuary Medical Aesthetic Center
Boca Raton, FL

Jason Pozner MD
Sanctuary Medical Aesthetic Center
Boca Raton, FL

Oprah to discuss bioidentical hormones tomorrow

As per this month's O! Magazine, Oprah Winfrey has been diagnosed with hyperthyroidism and has turned to bioidentical hormone therapy to treat the symptoms, along with the ill effects of being premenopausal. According to her website, tomorrow's Oprah program will be dedicated to a discussion of bioidentical hormone therapy.

We will be back tomorrow after the show with some words from Dr. Mitchell Matez, SMAC's resident expert on hormone replacement therapy.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

Here Comes Latisse

We've blogged about it here and here, and Natasha Singer of the NY Times is also on the scene, with today's article "Love the Long Eyelashes. Who's Your Doctor?"

The article cites annual revenue estimates for Allergan's upcoming eye-lash lengthening drug Latisse, ranging from $80 million in 2012 (via Gary Nachman of Leerink Swan), to $500 million "long-term" (coming from Allergan CEO David Pyott).

The meat of the article comes here:

"Allergan held a clinical trial with about 280 volunteers, half of whom used Latisse daily for 16 weeks. The study results were reviewed by the Food and Drug Administration, which approved the drug in late December. In that study, eyelashes typically grew 25 percent longer, 106 percent thicker and 18 percent darker. While 3.6 percent of patients experienced eye itching and red eyes, none had a change of eye color, Allergan said."

Stay tuned for more on this... articles like this hint that Latisse may become a household name next to Botox someday.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin and Laser Surgery Specialists of New York/New Jersey

Guest Post: Dr. Michael Gold on IMCAS

One of the most well-known speakers at IMCAS was Dr. Michael Gold, from Nashville, TN.

My IMCAS was varied this year - I talked about re-absorbable fillers in the U.S. - what differentiates them and what we need to look for from the FDA as far as safety is concerned - and these products are very safe in the right hands. I was also introduced to Europe Mentor's new toxin - PurTox - a pure neurotoxin finishing clinical trials in the U.S. - and the data associated with those trials.

I also presented on complications of lasers and IPLs - something that we don't usually spend a lot of time on at meetings but is one of the more important topics - I also did this with David Goldberg in the European Laser session. I reviewed what was new in cellulite and fat removal, focusing on the newer devices that are either new to the market or are close to becoming available on the market including for cellulite - SmoothShapes by Eleme (www.elememedical.com). and for body contouring Accent by Alma (www.almalasers.com), Skin Tyte by Sciton (www.sciton.com), Aluma by Lumenis (www.lumenis.com), Smartlipo by Cynosure (www.cynosure.com), ProLipo by Sciton (www.sciton.com), Liposonix for ultrasound fat destruction (www.liposonix.com), Zeltiq for cold fat destruction (www.zeltiq.com).

And I participated in two sessions on marketing - and how we do things in the US versus some of the restrictions in Europe.

The hottest topics by far were toxins and fillers - different from previous years where lasers were right up there - but seemed to be a little bit behind this year. The global economy seemed to have had this influence.

Dr. Michael Gold

Gold Skin Care

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

IMCAS: Glimpse of Ulthera

We are still extremely hot on Ulthera. This revolutionary device has the potential to upend the non-surgical facial rejuvenation market. It's still not approved in the US, but we feel that its skin thickness measuring aspects and ability to put targeted thermal zones into specific deeper tissue layers may be a way to non-surgically tighten facial skin.

As you can see, Dr. Pozner is very happy with the device.
Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center